Flexible Austerity: Negotiating the Unequal Effects of Resource Shortages in Racialized Organizations

Abstract

Resource shortages unfold unequally, often affecting the most socially disadvantaged people and exacerbating preexisting inequalities. Given that most resources are obtained through organizations, what role do organizational processes play in amplifying inequalities during shortages? I argue that workers engage in a practice I term flexible austerity. Flexible austerity describes how resource shortages become opportunities for decision-makers to more readily rationalize unequal resource allocation. I develop this concept by drawing on an ethnography of an urban academic hospital and leveraging data from before and during a nationwide shortage of medical intravenous (IV) opioids. I show that prior to this shortage, clinicians disproportionately assessed Black patients’ pain as “undeserving” of IV opioids, but they allocated these resources liberally because they felt constrained by evidence-based clinical best practices guidelines. During the shortage, clinicians constructed resource scarcity as necessitating austerity practices when treating Black patients, yet they exercised flexibility with White patients. This widened care disparities in ways that may have been detrimental to Black patients’ health. Based on these findings, I argue that resource shortages amplify inequalities in organizations because they provide new “colorblind” justifications for withholding resources that allow workers to link ideas of deservingness to allocation decisions.